At the present, more than half of the world's total population has ages suitable for working, i.e. they are aged in the range of 20-64 years. Considering the increase in the population that the working people are liable to look after, the health of the adult population at the working ages becomes more important. Today, there are a great many of health problems that affect the working adults. Of these, lumbar pains are one of the most significant, taking into account the labor loss they create and the economic losses they cause. The lumbar pain has a high prevalence in the range of 30-50 years, which is considered to be the productive age range. This condition restricts the activities of the individuals, leading to labor losses. Lumbar pain, which is indicated to be the disease ranked 2nd in terms of leading to the greatest extent of labor loss, after the respiratory tract infections, is frequently encountered in the industrialized societies. For example, it is indicated to be a health problem which 85% of the individuals in USA encounter in a period in their life. Although the economic data for Turkey are not exact, in USA, the lumbar pain is ranked the 2nd among the reasons for consulting a physician, the 3rd among the surgical practices, and the 5th among the causes for hospitalization. The expenses associated with the lumbar pain alone are estimated to be approximately 80 million dollars annually. (Nilay AYDO{hacek over (G)}AN, Patients' needs for information at the stage of discharge after being exposed to a surgical operation due to Lumbar Disc Hernia, Hacettepe University Institute of Health Sciences, Nursing Program in Surgical Diseases, Master of Science Thesis).
In USA, the lumbar pains are ranked the 4th after angina pectoris, hypertension and diabetes mellitus, in terms of health expenses, and an annual expense of 90.24 dollars is made per working individual. In addition, the lumbar pain-associated annual production loss is reported to be 28 million dollars and a workday loss of 149 million is estimated on a yearly basis. (Sema Pai, MPH, Lakshmi J., Sundaram, MIA, MPH Low Back Pam: An Economic Assessment in The United States Orthop Clin N Am 35, 1-5, 2004.)
In a study conducted at ukurova University Faculty of Medicine for determining the characteristics of the cases involving lumbar pain, an assessment of the diagnosis for the cases has revealed that the disc diseases are ranked the first with a rate of 27.7% (Kozano{hacek over (g)}lu, M.E., Demirkesen, A., Adam, M., Sarpel, T., Goncu, K., Characteristics of our Cases Involving Lumbar Pain, ukurova University Faculty of Medicine Journal, Volume: 22, No.: 4, 264267, 1997).
A large proportion of the patients complaining about the lumbar pain are known to be afflicted with disc herniation. In the studies performed, the lumbar disc herniations (LDH) are indicated to account for 90% of all the disc herniations.
Herniation is a condition in which the entirety or a part of an organ bulges out of a cavity, sheath or the region where it is required to be positioned as per the usual anatomic structure. Intervertebral disc herniation is the condition in which the nucleus pulposus protrudes outwards from the annulus fibrosus.
Disc hernia is the name given to the disease, which emerges from the pathological changes occurring in the shape and contents of discus intervertebralis as a result of the causes other than infection or tumor. Discus intervertebralis is the structure, which is present between the vertebras and is primarily responsible for the absorption and distribution of the axial loads imposed on the columna vertebralis. Lumbar disc herniations (LDH) comprise the most frequently encountered group among the disc herniations. And the majority of the cases are comprised by the lower lumbar disc herniations.
LDH is treated in three ways; conservative, surgical and chemonucleolysis. The basis of the conservative treatment is to protect the herniated disc from excessive strains and to promote the healing by way of fibrosis. The treatments employed for this purpose may be listed as bed rest, drug therapy, local injection, traction, manipulation and the back schools where the training is provided on the proper use of the body mechanics. Failure of the conservative treatment to be effective, aggravation of the pains, and development of the neurological deficits necessitate the surgery.
The treatment methods currently employed:
The first group of treatment methods comprises the surgical operations.
Surgical interventions carried out for this purpose are the procedures practiced using the discectomy, laminectomy and microsurgery techniques.
The disadvantages of this method are the individual's absence from the work for at least 1 week and the continued risks of anesthesia and operation during the convalescence (in case the patient has a chronic disorder, such as hypertension, diabetes mellitus, etc.). The phase of repetition of the treatment also brings about many problems.
Despite the advances in recent years in the surgical techniques for LDH, some complications may emerge in the postoperative period.
In addition to the general postoperative complications, these may be enumerated as neurovascular injuries (0.4%), cerebrospinal fluid leak (2.2%), disc space infection (1.5%), intermeningeal adherences and infection (1.6%), recurrence of a pain as severe as in the preoperative period (14%). The incidence of complications following the surgical intervention performed as a result of LDH is reported to be 5.5%. (Nilay AYDO{hacek over (G)}AN, Patients' needs for information at the stage of discharge after being exposed to a surgical operation due to Lumbar Disc Hernia, Hacettepe University Institute of Health Sciences, Nursing Program in Surgical Diseases, Master of Science Thesis).
Among the complications that might develop, the most significant one is the possibility for the recurrence of the herniation. It is known that, despite the surgical treatment applied, LDH usually recurs at a rate of 5-15% and that the technique employed, the level of herniation, inappropriate patient selection and the failure of the patient to act in compliance with the body mechanics in the postoperative period are effective in the development of recurrence. (Nilay AYDO{hacek over (G)}AN, Patients' needs for information at the stage of discharge after being exposed to a surgical operation due to Lumbar Disc Hernia, Hacettepe University Institute of Health Sciences, Nursing Program in Surgical Diseases, Master of Science Thesis).
Human vertebral discs undergo multi-functional biochemical and morphological changes with time. Along with the degeneration increased with passing age, there is also observed an increase in the frequencies of the disc herniation and lumbar pain. The degenerated discs spontaneously cause an increase in the amount of many inflammation mediators that play a role in degenerative processes. There is present a need for the studies aimed at clarifying the relations between the disease and these degenerative processes. Intervertebral discs are the non-vascular tissue elements surrounded by extracellular matrix. Although the annulus fibrosus has a predominantly collagen structure, the central cells thereof are rich in proteoglycans. It is believed that, along with aging, the decrease in the proteoglycans is a critical factor in the degeneration of the intervertebral discs. Many inflammation mediators are associated with the degeneration of the intervertebral discs, including nitric oxide (NO), interleukins, prostaglandin E2 (PGE2) and tumor necrosis factor alpha (TNF-alpha). In the studies conducted, many of these were shown to play a role in the deformation of the joint cartilage (Podichetty 2007).
It was shown that the hernial discs lead to a significant increase in the activity of metalloproteinase and the levels of NO, PFE2 and interleukin-6 as compared to the control discs, in the culture medium (Kang 1996). NO production occurs along with the degenerative lumbar problems, resulting from the increased NO synthase activity in the cerebrospinal fluid. However, the mechanisms of the inflammatory mediators including NO in these disorders have not been able to be definitely understood. Consecutive degenerative events lead the structural defects and the loss of normal motion (Podichetty 2007).
The second group of treatment methods comprise the physiotherapy.
The disadvantage of this method is the necessity for the individual to spare a certain time for traveling to the hospital for treatment for at least 10-15 days and also to spare a time period of at least 3-4 hours per day for resting in the post-treatment period.
The third group of treatment methods comprises the relaxation of the region by using the muscle relaxant medicines.
The disadvantage of this method is that such medicines, which are orally administered, trigger the stomach disorders, if any, of the individuals, due to the acidic properties thereof, once they have been dissolved in the stomach medium.
The studies conducted in the recent years indicate that the natural antioxidants, including also the volatile compounds available in the plants, may prevent the oxidative damage and thus, they may be protective against the processes of inflammatory cell aging (Khanna et al., 2007) and the neurodegenerative damage (Fusco et al).
Terpenoids, which constitute a great proportion of the chemical contents of the essential oils, pass through the cell membrane owing to their low molecular weight and thus, they induce different biological activities including the anti-inflammatory and anticholinesterase effects ([Chao et al, 2005], [Kulisic et al., 2007] and [Loizzo et al., 2007]).
The section provided above, which mentions the known aspects of the invention by way of the studies in the literature, is a description of the secondary effect intended to support the treatment of the pain resulting from the inflammation and edema that occur especially in the cases of disc hernia and sports injuries.